BMH Medical Journal 2015;2(3):84-88 Case Report Prosthetic Valve Endocarditis- Successful Management With Antimicrobial Treatment

Middle aged male was admitted with high fever, rigor and chills of 2 days duration. He was seen in the clinic two years back for syncope. He gave history of Mitral (Starr-Edward) and Aortic (Medtronic) valve replacement ten years earlier from another center and was on regular anticoagulation with dose-adjusted acenocoumarol. On evaluation he had normal prosthetic valve function by trans-thoracic echo, but Holter monitoring showed Paroxysmal Atrial Fibrillation. He had mild wall motion abnormalities and left ventricular dysfunction suggestive of coronary artery disease also and was put on additional Metoprolol. A few weeks prior to present episode, he had cranio-cerebral injury after a fall which he could not remember clearly. He underwent burr-hole evacuation of a hematoma from elsewhere. He had a short febrile episode during his hospital stay there and was treated with antibiotics, the details of which were not available. Physical examination on admission showed a very pale, ill-looking febrile person. Heart rate was 120 / min, in AF and BP was 100/70 mm Hg. Clubbing was present, but no petichiae, splenomegaly or other stigmata of infective endocarditis. Immediate trans-thoracic echo showed shagginess of mitral prosthetic valve, but no obstruction or significant regurgitation. Routine blood counts showe